Job Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

We are recruiting a Consultant Business Systems to join our Optum Application Managed Services (AMS) team.

The AMS team engages in short- and long-term commitments and partnerships and provides full service operational support to our clients with a proactive approach to business communication, efficiency, and problem resolution.

The AMS team partners with health plan clients to become an extension of their organization.

The highly seasoned staff is dedicated to managing Prospective Payment Systems (PPS) as well as looking at where PPS fits in the clients 'Ecosystem.'

AMS provides services that will help provide long term benefit for the client, not only direct resource savings, but also savings in process, manual effort and other operational areas.

The Consultant Business Systems is responsible for ensuring effective delivery of ongoing maintenance, supporting integration, configuration, and migration efforts. Consultant Business Systems are measured on service quality, systems knowledge development, and relationship building within assigned client portfolio.

Additionally, Consultant Business Systems may be responsible for project planning, client reporting, NPS improvement, and client by client SLA tracking.

The Consultant Business Systems must also have the ability to facilitate internal or external meetings and drive effective solutions.

The successful Consultant Business Systems candidate will have strong communications skills and the ability to liaison between technical and claims operations personnel.

Primary Responsibilities:

• PPS Client Support
• Ensures successful installation, implementation, and configuration
• Apply analytical / quantitative approach to problem solving
• Knows how to obtain and use data to support troubleshooting efforts
• Utilize communication skills to educate and inform
• Utilize one's solid interpersonal skills to work with all levels of management across all functional areas, as well as, business partners through internal entities
• Work within client ticketing system to track escalated issues, input new issues or answer issues sent in by other teams
• Communicate any responses back to client
• Implement changes as needed and outlined in contract
• Work directly with Optum colleagues and customers to determine and document Client PPS payment system methodology education or product training needs
• Works directly with customers to define other project requirements, provide assistance to answer questions related to project results
• Assist as needed with other Reimbursement Solutions projects
• Engage with dedicated clients either VPN or Remote, WebEx to apply updates or Troubleshoot issues using software documentation
• Compile Documentation: Processes and Procedures (including but not limited to Clients specific tracking, network configuration, rules of engagement)
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

User Responsibilities:
Leverage enterprise-approved AI tools to enhance productivity and innovation by streamlining workflows and automating repetitive tasks. Evaluate emerging trends to drive continuous improvement and strategic innovation.

Required Qualifications:

• Bachelor's degree or equivalent work experience
• 3+ years or experience working in a healthcare data or regulatory environment
• Experience with Prospective Payment System, Payment System Interface (PSI), Easy Group, Rate Manager
• Product support experience: configuring and customizing software solutions
• Experience with EasyGroup, Payment System Interface (PSI), Web.Strat and Rate Manager
• Experience pricing Medicare hospital facility claims (inpatient and outpatient)
• Experience breaking down information and developing solutions
  Health plan experience in facility contract configuration, claims or IT
• Experience documenting client operational and technical workflow
• Experience configuring and customizing software solutions
• Some Facility claims reimbursement experience - Medicare, Medicaid, Commercial
• Expert knowledge and understanding of Prospective Payment Systems - includes DRG, APC, OCE, ESRD, CAH, CMG, RUG, RBRVS
• Regulatory knowledge of Medicare, Medicaid Payment Systems
• Proven exposure to healthcare claims data, basic PPS concepts, UB04 and HCFA 1500 claim content
• Comfortable to work in 3 PM shift
• Client facing role - Proven excellent communication

Preferred Qualifications:

• Experience with Microsoft Word, Excel, PowerPoint, Visio
• Some SQL experience
• NET or IIS
• Experience with Tableau
• Claims system knowledge - Trizetto Facets, Networx Pricer, QNXT, Health Rules Payer, IKA Claims, Burgess Systems, Epic Tapestry, 3M

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.